STATE PROJECT OFFICE Affix
Application Fee SAMAGRA SHIKSHA, MIZORAM Passport
Rs. 50/- Here
INSTRUCTIONS FOR FILLING APPLICATION FORM
Only attested copies of certificates and marksheets required should be submitted along with the application.
Applications received after last date of submission of application fixed will not be entertained. Candidates
should check their applications carefully and see that the application are duly signed and complete in all
respects, including certificates to be attached.
Incomplete application will summarily be rejected.
Last date of submission 6.12.2024 (Friday) 4:00 p.m.
Candidates should bring Voters ID/Aadhaar Card at the time of Written Examination.
APPLICATION FORM
1. Post applied for & Name of School: 1. _______________________________________________________
2. _______________________________________________________
3.________________________________________________________
2. Name (in block letter) :____________________________________________________________
3. Father's Name :________________________________________________________
4. Mother's Name :________________________________________________________
5. Sex (tick the appropriate box) : Male Female Others
6. Permanent Address :_______________________________________________________
________________________________________________________
________________________________________________________
7. Present Address (if any) :_________________________________________________________
_________________________________________________________
_________________________________________________________
8. Telephone/Mobile No. (Preferably two contact numbers):__________________________________________
9. Date of Birth (attach supporting documents): Date Month Year
10. Nationality :________________________________________________________
11. Employment registration no. :________________________________________________________
(attach supporting documents)
12. Whether working knowledge of Mizo Language upto Middle School Standard is possessed or not (tick the
appropriate box): Yes No
13. Educational Qualification (attach supporting documents):
Sl. Exam passed/training Year of Division Percentage of Board or University
Subject
No obtained Passing /Class Marks obtained University
1
14. Experience (if any) (attach supporting documents):
a) ________________________________________________________________________________
b) ________________________________________________________________________________
c) ________________________________________________________________________________
15. Present Post Held (if any): __________________________________________________________________
16. If reservation/relaxation is claimed by Person with Disability indicate which (please supporting documents):
a) _____________________________________________________________________________
b) _____________________________________________________________________________
17. Indicate enclosures: a) ______________________________________________________________
b) ______________________________________________________________
c) ______________________________________________________________
d) ______________________________________________________________
e) ______________________________________________________________
f) __________________________________________________________
g) __________________________________________________________
DECLARATION
I hereby declare that all the statements made in this application are true and complete to the best of my
knowledge and belief. I understand that action can be taken against me by the Department if I am declared to be
guilty of any falsification of statements/documents.
Place : __________________________
Date : __________________________
(Signature of the candidate)
(in full)